• Nenhum resultado encontrado

Does acupuncture work? Is there any evidence?

N/A
N/A
Protected

Academic year: 2017

Share "Does acupuncture work? Is there any evidence?"

Copied!
2
0
0

Texto

(1)

EDITORIAL

Sao Paulo Med J. 2006;124(3):119-20.

Álvaro Nagib Atallah

Does acupuncture work?

Is there any evidence?

There is no lack of evidence regarding acupuncture. A search in PubMed just for clinical trials brings up 3,707 references on acupuncture. If the search is for systematic reviews over the last fi ve years alone, around 250 articles will be identifi ed.

As is well known, not all the 3,707 articles located as clinical trials will in fact be this type, and the same goes for systematic reviews. There will be a need to critically evaluate each reference and separate the wheat from the chaff.

It would thus be better to search from the starting point of a question. The fi rst step should be to formulate specifi c questions. Each question will require at least the following items:

1) The health problem

2) The intervention (type of acupuncture)

3) Control intervention (placebo, false acupuncture, waiting list, drugs, etc.)

4) The outcome (cure, disappearance of the pain, return to work, etc.).

Another strategy that is very effi cient is to put these words that form the question in the search location for the Cochrane Library, which has been free to access in Brazil for around fi ve years (www.bireme.br/cochrane). Doctors and lay people can access it, and there is an article in Diagnóstico e Tratamento1 that gives guidance on how to better exploit

the Cochrane Library.

In the Cochrane Library, readers will fi nd 13 completed systematic reviews (best level of evidence) and 12 clinical pro-tocols, i.e. systematic reviews that are in progress, for which the complete text is expected to become available within six to twelve months, approximately, about acupunture.

Only two of the completed reviews in the Cochrane Library2-13 present results that provide support for the use

of acupuncture: acupuncture for post-chemotherapy nausea and vomiting without the use of antihemetic drugs, and for idiopathic headache. Other reviews show a lack of convinc-ing effects from acupuncture in relation to smokconvinc-ing, cocaine dependence, schizophrenia treatment, etc.

In many cases, there is a lack of evidence to base deci-sions on. Lack of evidence must not, however, be confused with lack of effects. Lack of evidence means that the therapy has not been studied through adequate clinical trials. Lack of effect means that randomized controlled studies with adequate sample sizes, adequate control groups, reliable measurements of outcomes, etc., have been conducted but that improvements were not observed more frequently in the treated group than in the control group.

For professionals who are looking for good evidence in order to know whether or not to refer a patient for acupunc-ture treatment, this may be bad news. This is also the situa-tion with a good proporsitua-tion of allopathic treatments, many of which extremely expensive and barbaric.

On the other hand, professionals who wish to contribute towards medical knowledge and towards enlightening health-care through new knowledge may conduct controlled clinical trials to evaluate acupuncture or allopathic therapy, since these open the door, if not to paradise then to an extremely important and fruitful professional activity.

So, what purpose have the completed systematic reviews served in relation to answering specifi c questions? After all, these reviews have not found enough clinical trials to constitute evidence in favor of or against such procedures. Nonetheless, they have served exactly this purpose: to show that more and better clinical trials are needed on this subject. And they have shown what characteristics such studies must have in order to defi nitively reduce the uncertainties to a point at which there will be reasonable evidence regarding the effectiveness, effi ciency and safety of each treatment or preventive measures. In this respect, the Cochrane Collabora-tion has contributed greatly, through establishing the basis for true scientifi c progress for the benefi t of human health.

(2)

120

Sao Paulo Med J. 2006;124(3):119-20. century. The exhibition continues in London

until October. The Founder of the Cochrane Collaboration, Sir Iain Chalmers, was one of those chosen. He refused to accept this hom-age alone and demanded that those who had collaborated through their work should also be represented with their photographs. The

present humble collaborator thanks him for the honor of being remembered as part of the group receiving the homage, but also acknowl-edges that everyone who has collaborated with us in Brazil and abroad also deserves similar homage. Since the Brazilian Cochrane Center reaches its tenth anniversary this year, we will

1. El Dib RP, Atallah AN. Cochrane Library: como pesquisar? Diagn Tratamento. 2005;10(1):31-4.

2. Furlan AD, van Tulder MW, Cherkin DC, et al. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev. 2005;25(1):CD001351.

3. Casimiro L, Barnsley L, Brosseau L, et al. Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis. Cochrane Database Syst Rev. 2005;19(4):CD003788. 4. White AR, Rampes H, Campbell JL. Acupuncture and related

interventions for smoking cessation. Cochrane Database Syst Rev. 2006;25(1):CD000009.

5. Zhang SH, Liu M, Asplund K, Li L. Acupuncture for acute stroke. Cochrane Database Syst Rev. 2005;18(2):CD003317. 6. He L, Zhou D, Wu B, Li N, Zhou MK. Acupuncture for Bell’s

palsy. Cochrane Database Syst Rev. 2004;(1):CD002914. 7. McCarney RW, Brinkhaus B, Lasserson TJ, Linde K.

Acu-puncture for chronic asthma. Cochrane Database Syst Rev. 2004;(1):CD000008.

8. Smith CA, Hay PP. Acupuncture for depression. Cochrane Database Syst Rev. 2005;18(2):CD004046.

9. Melchart D, Linde K, Fischer P, et al. Acupuncture for idiopathic headache. Cochrane Database Syst Rev. 2001;(1):CD001218.

10. Smith CA, Crowther CA. Acupuncture for induction of labour. Cochrane Database Syst Rev. 2004;(1):CD002962. 11. Green S, Buchbinder R, Barnsley L, et al. Acupuncture for

lateral elbow pain. Cochrane Database Syst Rev. 2002;(1): CD003527.

12. Green S, Buchbinder R, Hetrick S. Acupuncture for shoulder pain. Cochrane Database Syst Rev. 2005;18(2): CD005319.

13. Gates S, Smith LA, Foxcroft DR. Auricular acupuncture for cocaine dependence. Cochrane Database Syst Rev. 2006;25(1):CD005192.

REFERENCES attempt to do the same, by paying homage to all friends and collaborators.

Referências

Documentos relacionados

Deste modo, apesar de a “Coluna Solar” ser um candeeiro de iluminação pública, não são aplicáveis todas as prescrições da norma pelo facto de os níveis de tensão

according to their MS 2 fragmentation as different isomers of p-coumaroyl quinic acid. Identities were assigned based on the patterns reported for the caffeoylquinic acid

Para sistemas formados por água, solvente orgânico e etanol, provaram que a adição de sal aumenta a solubilidade de etanol na fase orgânica, pois o sal modifica o equilíbrio de

Pode-se averiguar também, em relação hipótese formulada sobre a redução do déficit habitacional das camadas mais baixas, que ao se comparar as duas fases, há um

Lorca es el último centro emisor de turístico religioso y cultural al Santuario de Santa Eulalia de Mérida (en término de Totana), que también acapara visitas

Este dispositivo tem como zona de aplicação a retificadora presente na linha produtiva das coroas, mais propriamente a calha de carregamento das mesmas para o seu processamento, e

Nesse sentido, em Vício as relações estabelecidas são, antes de mais, e de forma muito clara, com O Primo Basílio, mas também com a obra poética do primeiro. Vítor Manuel Aguiar

Esta interpretação da História subsume-se, então, numa pedagogia do ser português, concebida como o culto de uma pátria e de uma cultura, enquanto tradição, harmonia triunfante